Patient's question:
My husband has severe oligoasthenozoospermia, with sperm density less than 210^6/ML. There are almost no A/B grade sperm. We have been married for five years and have not been able to conceive.Doctor's answer:
The male has a balanced translocation. Theoretically, the sperm produced would be 1/18 normal, 1/18 balanced, and the rest would be unbalanced sperm, which could increase the early miscarriage rate in the female and the risk of congenital defects in the fetus. Although the theoretical probability of bad outcomes is relatively high, due to the large number of sperm released during a single ejaculation by the male and the rigorous internal selection process in the female's body, the natural selection process leads to a lower actual miscarriage rate.For your situation, if the male's semen quality is acceptable, the first recommendation is to try pregnancy again after adjusting both partners' conditions and avoiding other potential factors that could cause early miscarriage or fetal defects. It is recommended to undergo amniocentesis between the 16th and 20th weeks of pregnancy to rule out any adverse fetal conditions. The first recommendation has a significant element of luck, but I have seen many cases in my patients where good outcomes occurred due to good fortune. This is also the most ethically and economically suitable choice for Chinese people.
If the male's semen quality is poor and in vitro fertilization (IVF) is already necessary, the second recommendation is IVF, which can be divided into two types:
1. Conventional IVF: This carries a relatively higher risk of miscarriage for the female, but we have had several cases of successful births. Essentially, it involves using embryos from IVF for pregnancy.
2. Preimplantation Genetic Diagnosis (PGD): This requires IVF technology to perform invasive testing on early embryos, normal or balanced embryos for transfer. The characteristics of this method are:
- Relies on IVF technology
- Requires good conditions and ovarian function in the female
- Expensive
- Invasive testing of early embryos
- World-reported clinical pregnancy rates range from 16-25%
- Can reduce the risk of natural miscarriage but does not guarantee it. The natural miscarriage rate for ordinary adult couples has been increasing in recent years, with current reports indicating a rate of 15-20%. Additionally, once IVF is performed, it is generally not possible to return to natural pregnancy attempts, and future attempts will likely require IVF. Therefore, unless IVF is already necessary, the first recommendation is usually not pursued.
If there is repeated miscarriage, fetal abnormalities, or severe male oligoasthenozoospermia where IVF is not desired, the third recommendation is donor insemination or adoption. The prerequisite for donor insemination is that the female has normal fallopian tube patency. Moreover, if the male has sperm, donor insemination is generally not considered.
For specific advice, please consult a doctor.
Regarding pre-pregnancy preparation:
- The female's egg maturation cycle is approximately 80 days, meaning that eggs released in the current month began growing two and a half months prior.
- The male's spermatogenesis cycle is three months, so both partners should ideally start preparing three months before pregnancy.
- You can begin by adjusting your lifestyle. For example:
- Drink 2,000–3,000 ml of plain water daily to help detoxify.
- Ensure sleep between 10 PM and 3 AM daily, avoiding late nights as this is the best time for rest and recovery.
- Consume fresh fruits and vegetables to enhance antioxidant capacity.
- Avoid smoking and alcohol, and avoid toxic or harmful environments.
- The female should take folic acid and vitamins for three months before pregnancy and during the early stages of pregnancy.
- The female is recommended to undergo a TORCH test before pregnancy to ensure normal results before conception.